A reappraisal of norepinephrine therapy in human septic shock

Desjars, P; Pinaud, M∘; Potel, G.; Tasseau, F.; Touze, Marie-Dominique

doi:10.1097/00003246-198702000-00011

Cited by 237 publications

(61 citation statements)

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“…Several observational studies show that noradrenaline is the vasoconstrictive agent of choice, which combines the best compromise in term of cost, safety and ease of use [111][112][113][114][115][116][117]. There is no controlled study concerning this specific point.…”

Section: (Grade 2+) Strong Agreementmentioning

confidence: 99%

Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies)

Ichai

Vinsonneau

Souweine

et al. 2016

Anaesthesia Critical Care & Pain Medicine

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Acute kidney injury (AKI) is a syndrome that has progressed a great deal over the last 20 years. The decrease in urine output and the increase in classical renal biomarkers, such as blood urea nitrogen and serum creatinine, have largely been used as surrogate markers for decreased glomerular filtration rate (GFR), which defines AKI. However, using such markers of GFR as criteria for diagnosing AKI has several limits including the difficult diagnosis of non-organic AKI, also called "functional renal insufficiency" or "pre-renal insufficiency". This situation is characterized by an oliguria and an increase in creatininemia as a consequence of a reduction in renal blood flow related to systemic haemodynamic abnormalities. In this situation, "renal insufficiency" seems rather inappropriate as kidney function is not impaired. On the contrary, the kidney delivers an appropriate response aiming to recover optimal systemic physiological haemodynamic conditions. Considering the kidney as insufficient is erroneous because this suggests that it does not work correctly, whereas the opposite is occurring, because the kidney is healthy even in a threatening situation. With current definitions of AKI, normalization of volaemia is needed before defining AKI in order to avoid this pitfall.

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Section: (Grade 2+) Strong Agreementmentioning

confidence: 99%

Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies)

Ichai

Vinsonneau

Souweine

et al. 2016

Anaesthesia Critical Care & Pain Medicine

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“…In patients with IAH and septic shock, use of norepinephrine (NE) probably has an appropriate effect on maintaining renal perfusion. NE has been reported to increase renal blood flow, urine output and creatinine clearance in experimental and human sepsis through a combined increase of renal perfusion pressure and an increase in renal vascular conductance [95][96][97][98] . Norepinehrine is more potent than dopamine at doses ranging from 0.01-3.3 µg/kg/min to achieve increase of MAP in hypotensive patients after fluid resuscitation 98,99 .…”

Section: Renal Function Supportive Measuresmentioning

confidence: 99%

Acute kidney injury following acute pancreatitis: A review

Petejová¹,

Martínek²

2013

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Backround. Acute kidney injury (AKI) is a common serious complication of severe acute pancreatitis (SAP) and an important marker of morbidity and mortality in critically ill septic patients. AKI due to severe acute pancreatitis can be the result of hypoxemia, release of pancreatic amylase from the injured pancreas with impairment of renal microcirculation, decrease in renal perfusion pressure due to abdominal compartment syndrome, intraabdominal hypertension or hypovolemia. Endotoxins and reactive oxygen species (ROS) also play an important role in the pathophysiology of SAP and AKI. Knowledge of the pathophysiology and diagnosis of AKI following SAP might improve the therapeutic outcome of critically ill patients. Methods and Results. An overview of the pathophysiology, diagnosis and potential treatment options based on a literature search of clinical human and experimental studies from 1987 to 2013. Conclusions. Early recognition of AKI and SAP in order to prevent severe complication like septic shock, intraabdominal hypertension or abdominal compartment syndrome leading to multiple organ dysfunction syndrome is a crucial tool of therapeutic measures in intensive care.

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“…When fluid administration fails to restore an adequate perfusion pressure, and patients do not respond to dopamine or dobutamine, NE is used with the assumption that restoration of 'physiological' blood pressure will improve organ perfusion. Relevant clinical studies are summarized in table 2 [56][57][58][59][60][61][62][63][64][65]. Most of these studies are uncontrolled, many of them even retrospective, and concern a limited number of patients.…”

Section: Clinical Studiesmentioning

confidence: 99%

Vasopressors and the Kidney

Schetz¹

2002

Blood Purif

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The changes in renal perfusion induced by vasopressors depend on their effects on systemic hemodynamics and renal vascular resistance. Both effects are largely influenced by the patient’s underlying condition such as myocardial contractility and vascular responsiveness. A beneficial effect can be expected if mean arterial pressure increases without decreasing cardiac output and if the effect on renal vascular resistance is less pronounced than on systemic vascular resistance. Acute renal failure is associated with loss of renal autoregulation and sepsis is associated with blood pressures below the autoregulatory threshold. Both conditions might therefore benefit from the administration of vasopressors. Many experimental and clinical data indeed suggest a beneficial effect of norepinephrine on the urine output in sepsis. A beneficial effect on renal function (glomerular filtration) is a less consistent finding suggesting that pressure diuresis might be partially responsible for the pressor-induced diuresis. Administration of vasopressors to patients with oliguria should be considered in fluid-resuscitated patients with distributive shock. Whether other vasopressors offer advantages over norepinephrine requires further investigation.

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A reappraisal of norepinephrine therapy in human septic shock

Cited by 237 publications

References 0 publications

Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies)

Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies)

Acute kidney injury following acute pancreatitis: A review

Vasopressors and the Kidney

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